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The effect of age and time to death on primary care costs: The Italian experience

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  • Atella, Vincenzo
  • Conti, Valentina

Abstract

A large body of literature shows that time to death (TTD) is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of primary care costs (pharmaceuticals, diagnostic tests and specialist visits) in Italy, where they represent an important share (about 30%) of the total health care expenditure (HCE). Our analysis is based on a large sample of the Italian population (about 750,000 individuals), obtained from the Health Search-SiSSI database, which contains patient-level data collected routinely by General Practitioners in Italy since 2002. We study individuals aged 19 and older, over the period 2006–2009. By means of a two-part model which accounts for the presence of zero expenditure, our findings show that age represents the most important driver of primary care costs in Italy, although TTD remains a good predictor. These results suggest that age and TTD can have a different role in shaping health care costs according to the component of health expenditure examined. Therefore, our advice to policy makers is to use disaggregated models to better disentangle these contributions and to produce more reliable health spending forecasts.

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  • Atella, Vincenzo & Conti, Valentina, 2014. "The effect of age and time to death on primary care costs: The Italian experience," Social Science & Medicine, Elsevier, vol. 114(C), pages 10-17.
    • Handle: RePEc:eee:socmed:v:114:y:2014:i:c:p:10-17
    DOI: 10.1016/j.socscimed.2014.05.029
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    1. Brigitte Dormont & Hélène Huber, 2006. "Causes of Health Expenditure Growth: the Predominance of Changes in Medical Practices Over Population Ageing," Annals of Economics and Statistics, GENES, issue 83-84, pages 187-217.
    2. Peter Zweifel & Stefan Felder & Andreas Werblow, 2004. "Population Ageing and Health Care Expenditure: New Evidence on the “Red Herring”," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 29(4), pages 652-666, October.
    3. Andreas Werblow & Stefan Felder & Peter Zweifel, 2007. "Population ageing and health care expenditure: a school of ‘red herrings’?," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1109-1126, October.
    4. Albert Wong & Pieter H. M. van Baal & Hendriek C. Boshuizen & Johan J. Polder, 2011. "Exploring the influence of proximity to death on disease‐specific hospital expenditures: a carpaccio of red herrings," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 379-400, April.
    5. repec:adr:anecst:y:2006:i:83-84:p:08 is not listed on IDEAS
    6. Felder, Stefan & Werblow, Andreas & Zweifel, Peter, 2010. "Do red herrings swim in circles? Controlling for the endogeneity of time to death," Journal of Health Economics, Elsevier, vol. 29(2), pages 205-212, March.
    7. Baoping Shang & Dana Goldman, 2008. "Does age or life expectancy better predict health care expenditures?," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 487-501, April.
    8. repec:dau:papers:123456789/1630 is not listed on IDEAS
    9. Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
    10. Breyer, Friedrich & Felder, Stefan, 2006. "Life expectancy and health care expenditures: A new calculation for Germany using the costs of dying," Health Policy, Elsevier, vol. 75(2), pages 178-186, January.
    11. de Meijer, Claudine & Koopmanschap, Marc & d' Uva, Teresa Bago & van Doorslaer, Eddy, 2011. "Determinants of long-term care spending: Age, time to death or disability?," Journal of Health Economics, Elsevier, vol. 30(2), pages 425-438, March.
    12. Zhou Yang & Edward C. Norton & Sally C. Stearns, 2003. "Longevity and Health Care Expenditures," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 58(1), pages 2-10.
    13. Karlsson, Martin & Klohn, Florian, 2011. "Some notes on how to catch a red herring Ageing, time-to-death & care costs for older people in Sweden," Publications of Darmstadt Technical University, Institute for Business Studies (BWL) 77470, Darmstadt Technical University, Department of Business Administration, Economics and Law, Institute for Business Studies (BWL).
    14. Sally C. Stearns & Edward C. Norton, 2004. "Time to include time to death? The future of health care expenditure predictions," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 315-327, April.
    15. W. M. T. Westerhout, 2006. "Does Ageing Call for a Reform of the Health Care Sector?," CESifo Economic Studies, CESifo Group, vol. 52(1), pages 1-31, March.
    16. Peter Zweifel & Stefan Felder & Markus Meiers, 1999. "Ageing of population and health care expenditure: a red herring?," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 485-496, September.
    17. Karlsson, Martin & Klohn, Florian, 2011. "Some notes on how to catch a red herring - Ageing, time-to-death and care costs for older people in Sweden," HERO Online Working Paper Series 2011:6, University of Oslo, Health Economics Research Programme.
    18. Andreas Werblow & Stefan Felder & Peter Zweifel, 2007. "Population ageing and health care expenditure: a school of 'red herrings'?," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1109-1126.
    19. Meena Seshamani & Alastair Gray, 2004. "Ageing and health‐care expenditure: the red herring argument revisited," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 303-314, April.
    20. Christian Salas & James P. Raftery, 2001. "Econometric issues in testing the age neutrality of health care expenditure," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 669-671, October.
    21. Polder, Johan J. & Barendregt, Jan J. & van Oers, Hans, 2006. "Health care costs in the last year of life--The Dutch experience," Social Science & Medicine, Elsevier, vol. 63(7), pages 1720-1731, October.
    22. Gerdtham, Ulf-G., 1993. "The impact of aging on health care expenditure in Sweden," Health Policy, Elsevier, vol. 24(1), pages 1-8, April.
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    2. Breyer, Friedrich & Lorenz, Normann & Ihle, Peter, 2020. "Aging and Health Care Expenditure: A non-parametric approach," VfS Annual Conference 2020 (Virtual Conference): Gender Economics 224635, Verein für Socialpolitik / German Economic Association.
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    4. Caravaggio, Nicola & Resce, Giuliano, 2023. "Enhancing Healthcare Cost Forecasting: A Machine Learning Model for Resource Allocation in Heterogeneous Regions," Economics & Statistics Discussion Papers esdp23090, University of Molise, Department of Economics.
    5. Vincenzo Atella & Federico Belotti & Valentina Conti & Claudio Cricelli & Joanna Kopinska & Andrea Piano Mortari, 2016. "Modeling public health care expenditure using patient level data: Empirical evidence from Italy," CEIS Research Paper 367, Tor Vergata University, CEIS, revised 10 Feb 2016.
    6. Federico Belotti & Joanna Kopinska & Alessandro Palma & Andrea Piano Mortari, 2022. "Health status and the Great Recession. Evidence from electronic health records," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1770-1799, August.
    7. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    8. Sungje Moon & Mankyu Choi, 2018. "The Effect of Usual Source of Care on the Association of Annual Healthcare Expenditure with Patients’ Age and Chronic Disease Duration," IJERPH, MDPI, vol. 15(9), pages 1-11, August.
    9. Friedrich Breyer & Normann Lorenz, 2021. "The “red herring” after 20 years: ageing and health care expenditures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 661-667, July.
    10. Maynou, Laia & Street, Andrew & García−Altés, Anna, 2023. "Living longer in declining health: Factors driving healthcare costs among older people," Social Science & Medicine, Elsevier, vol. 327(C).
    11. Domenico Depalo & Jay Bhattacharya & Vincenzo Atella & Federico Belotti, 2019. "When Technological Advance Meets Physician Learning in Drug Prescribing," NBER Working Papers 26202, National Bureau of Economic Research, Inc.
    12. Wenqiang Qian & Xiangyu Cheng & Guoying Lu & Lijun Zhu & Fei Li, 2019. "Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds: Evidence from China," Sustainability, MDPI, vol. 11(8), pages 1-21, April.
    13. Anne Mason & Idaira Rodriguez Santana & María José Aragón & Nigel Rice & Martin Chalkley & Raphael Wittenberg & Jose-Luis Fernandez, 2019. "Drivers of health care expenditure: Final report," Working Papers 169cherp, Centre for Health Economics, University of York.
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